(PS9-41) Barriers and Facilitators to Implementation of an Early Childhood Executive Function Intervention

Executive function (EF), which includes skills such as flexibility and planning, is impaired across neurodevelopmental disorders. Early EF is a strong predictor of outcomes in quality of life, health, educational attainment, and independent living, even after controlling for IQ and socioeconomic status. Effective and accessible early EF interventions have the potential to reduce disparities experienced by neurodivergent children. Unstuck and On Target-Early Childhood (UOT-EC) is a novel executive function intervention for 3-6 year-olds with teacher-identified problems with behavioral and cognitive flexibility, developed from the evidence-based Unstuck and On Target executive function intervention for neurodivergent elementary school students.

When evidence-based interventions are implemented in different contexts, barriers and facilitators to their delivery and sustainment are important to understand so that implementation can be improved. Community engagement in the development and evaluation of new interventions can help to identify potential barriers and facilitators to its eventual dissemination and implementation, thus escalating the pace of uptake and reducing the research-to-practice gap. Using a sequential explanatory mixed methods design, assessments of acceptability, feasibility, appropriateness, and contextual barriers/facilitators were integrated to understand the experiences of implementers delivering UOT-EC.

UOT-EC was developed with input from community partners and piloted in two distinct early childhood education settings by community implementers. The Feasibility of Intervention Measure (FIM), Intervention Appropriateness Measure (IAM), and Acceptability of Implementation (AIM; Weiner et al., 2017) measures collected by implementers at baseline and post-intervention tests for improvements in the feasibility, appropriateness, and acceptability of UOT-EC. These measures are short (4-items each). Items are rated on a 1-5 scale, with higher scores indicating higher perceptions of fit. A subset of implementers were purposively selected for key informant interviews based on school setting and quantitative survey results. The semi-structured interview guide addressed the contextual domains of the Consolidated Framework for Implementation Research (CFIR 1.0; Damschroder et al., 2009) and RE-AIM framework (Glasgow et al., 2019). Interviews were transcribed verbatim and analyzed using rapid qualitative methods. Implementers (N=9) agreed that Unstuck was feasible (94%), acceptable (92%), and appropriate (92%) for delivery in their schools. Rapid qualitative analysis of interviews (N=5) revealed a range of barriers and facilitators influencing implementers’ experiences with UOT-EC. Implementers made several adaptations to Unstuck to increase its fit with their school settings. Results highlight adaptations that may be helpful in improving the fit between Unstuck and school contexts, as well as multilevel barriers and facilitators to delivery. Future work will identify implementation strategies to reduce barriers and leverage facilitators to increase the reach, effectiveness, adoption, implementation, and maintenance of Unstuck in diverse school settings.